Common Practice: Spillovers from Medicare on Private Health Care

Why consumers disenroll from Medicare private health plans.

Ms. H has Medicare due to a disability and was in a Medicare private health plan. She chose this particular plan because it had a cap on out-of-pocket payments. She discovered, however, that the cap did not always apply to her cancer treatments, and her out-ofpocket costs were higher than she had expected. Fortunately, Ms. H’s husband was starting a new job, and she was able to disenroll and ge...

Medicare, managed care, and behavioral health care.

The Medicare Physician Group Practice Demonstration: Lessons Learned on Improving Quality and Efficiency in Health Care

In April 2005, the Centers for Medicare and Medicaid Services (CMS) initiated the Physician Group Practice demonstration, which offers 10 large practices the opportunity to earn performance payments for improving the quality and cost-efficiency of health care delivered to Medicare fee-for-service beneficiaries. This report is based on the proceedings of a 2006 site conference held in Baltimore ...

Medicare: Private-Sector and Federal Efforts to Assess Health Care Quality

Multiple payers, commonality and free-riding in health care: Medicare and private payers.

Managed health care plans and providers in the US and elsewhere sell their services to multiple payers. For example, the three largest groups of purchasers from health plans in the US are employers, Medicaid plans, and Medicare, with the first two accounting for over 90% of the total enrollees. In the case of hospitals, Medicare is the largest buyer, but it alone only accounts for 40% of the to...